How to overcome depression and anxiety?

Question

Hi doctor,

I am a 28-year-old male with a weight of 147 pounds and a height of 5 feet 8 inches. I have been diagnosed with depression and anxiety. I was initially prescribed Clonazepam (0.5 mg, later reduced to 0.25 mg) and Escitalopram (20 mg until last week). While my anxiety is under good control, my depression persists. I have been switched to Fluoxetine 20 mg, along with 0.25 mg of Clonazepam.

I am describing the primary symptoms that have been troubling me and persistent for almost two years. I experience emotional numbing and dissociation, feeling as though I am merely passing time rather than truly living. I feel as though I am lacking a connection between my heart and mind, and struggling with severe motivation issues. I have very low energy and feel sleepy all the time, even after eight to ten hours of sleep. I lack confidence and want to address these issues as soon as possible, as they are significantly impacting my life and work.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Based on the available information, it seems you have experienced a partial response to medication, resulting in incomplete treatment. Given this situation, we have two options for managing your current condition:

Increase the Fluoxetine dose to 40 mg and wait three weeks before considering further changes.
Add Bupropion 300 mg per day to your current Fluoxetine 20 mg regimen.

Considering your symptoms of low motivation, emotional numbing, loss of interest, and decreased energy, the second option may be more appropriate for you. Bupropion is typically started at 150 mg per day, taken in the morning, and increased to 300 mg after four to seven days of initial treatment. Consult your specialist doctor, discuss with him or her, and take the medicines with take the medicines with their consent. This medication requires a prescription, so you will need one to purchase it from the pharmacy.

I hope this helps you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I am glad to see that you have a good insight into your condition, which is likely to aid you during your treatment. However, it is important to address the negative emotions associated with this insight effectively. Although this will require significant effort, I am here to help you adjust your approach to better manage these feelings.

Firstly, it is crucial to understand that we cannot change the past. What has happened is over and cannot be undone. Instead of dwelling on it, focus on learning from these experiences and accept that they are beyond your control.

Secondly, immerse yourself in activities that keep your mind occupied. Avoid leaving idle time for negative thoughts to intrude. Engaging in positive activities can be far more beneficial than ruminating on past events.

Lastly, connect with family and friends. Isolation and keeping your thoughts to yourself are unlikely to be helpful. Reaching out and maintaining connections with others can provide support and perspective.

I hope these suggestions are helpful. Feel free to reach out if you have more questions.

Thanks and regards.

Answer 3

Hi,

Welcome back to icliniq.com.

Thanks for the follow-up.

While many disorders can present with symptoms similar to anxiety and depression, the following conditions are often associated with these symptoms and may resolve once the underlying issue is addressed:

Thyroid disorders (both hyperthyroidism and hypothyroidism).
Pheochromocytoma.
Vitamin B12 deficiency.
Vitamin D deficiency.
Developing depression.
Side effects from various medications (such as steroids, anti-tubercular medications, and beta-blockers).
Various neurological disorders.

For the first three conditions, brain imaging is recommended to rule out neurological disorders. For the other issues, it is important to evaluate additional symptoms that may not be explained by anxiety and depression alone.

I hope this information is helpful.

Thank you.